47% oppose mandatory shots

38% believe they are a good idea for girls

Feb. 22, 2007

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ABOUT THE VACCINE

What it does: Protects against four strains of the sexually transmitted human papillomavirus, also known as HPV. Two strains cause about 70 percent of cervical cancer cases.

Who should get it: The FDA approved the vaccine for girls and women 9 to 26 years old. The CDC recommended it for girls 11 and 12. The vaccine is not approved for boys, but Merck is evaluating its safety and effectiveness in males.

Young recipients: It is most effective when given before sexual activity begins. However, even those who may have been exposed to one strain of HPV may still benefit because the vaccine protects them against three other strains as well.

Safety and effectiveness: According to the U.S. Food and Drug Administration, four studies were conducted in 21,000 women to show how well Gardasil worked in women 16 to 26 years old. Two studies were also performed measuring the immune response among girls 9 to 15 years old. Gardasil's safety was evaluated in about 11,000 people, and most reactions were mild or moderate, such as pain or tenderness at the injection site. The manufacturer agreed to continue evaluating the safety and long-term effectiveness.

New reports of side effects: More than 500 cases of mostly minor side effects have been reported in girls and women who got the vaccine, The Associated Press reports. Many of the incidents involved fainting, but teens tend to faint from vaccinations anyway, and the number of cases doesn't exceed what was expected. Government officials say no additional warning labels are necessary. In total, there were 542 adverse health complaints, with injection site soreness reported by nearly 20 percent, fainting or dizziness by 11 percent and fever or nausea reported in 9 percent.

Shots: Three doses are involved. The second dose comes two months after the first one, and the third one at least four months after the second one.

Cost: Merck has set the price at $360 for the series of shots, but some doctors add extra charges, such as stocking fees. Insurance may cover at least some of the costs; check with your insurance company.

Availability: Call your doctor to find out if they offer it. The Louisville Metro Department of Public Health and Wellness doesn't yet offer the vaccine but plans to soon.

Sources: Lesley Lantz, a nurse practitioner with OB-GYN Associates of Southern Indiana in New Albany; U.S. Food and Drug Administration; U.S. Centers for Disease Control and Prevention.

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As the mother of an 11-year-old girl, Marie Mazzotta doesn't like the idea of requiring Kentucky's middle school girls to be vaccinated against a sexually transmitted virus that may cause cervical cancer.

"It should be my choice," she said.

The latest Courier-Journal Bluegrass Poll shows that more Kentuckians agree with her than disagree.

The survey of 801 Kentucky adults, conducted between Feb. 8-14, showed that 47 percent oppose making the vaccine mandatory, while 38 percent favor it and 15 percent are undecided.

The poll asked about the issue as Kentucky legislators consider a bill that would require public and private middle school girls to receive three shots of a vaccine called Gardasil, but would let parents opt out by completing a form.

The controversial bill is similar to those introduced in about 20 other states. Such legislation had been the subject of a lobbying campaign by vaccine-maker Merck & Co. until the company suspended its effort earlier this week. In Indiana, the state Senate has approved legislation requiring schools to send home information about Gardasil to the parents of girls entering sixth grade.

Proponents of mandatory vaccination in Kentucky say it would save lives and reduce suffering in a state with the second-highest cervical cancer death rate in the nation.

"If you can prevent cancer -- and that's what this does -- then why not?" asked poll respondent Thomas "Ken" Bolton, 74, of Louisville. "It just makes sense to me. It's a no-brainer."

The poll showed that among certain demographic groups -- such as African Americans and Jefferson County residents -- more people favor than oppose requiring the vaccine. Women were more likely than men to favor it, although more oppose than favor it in both gender groups. People 18-34 were also more likely to support mandatory vaccination than people 35 and older.

Opponents say requiring the vaccination would take away parental rights and possibly give girls implicit permission to have sex. Some also express concerns about the long-term safety of Gardasil, approved by the federal government last June for girls and women ages 9-26.

"It's a new vaccine," said Mazzotta, a 41-year-old stay-at-home mother from Louisville. "I'm not going to play around with my child's health."

She said Gardasil is unlike many other vaccines required for school attendance because it doesn't target a disease that can easily be spread in the classroom. Instead, it protects against strains of human papillomavirus that cause 70 percent of all cervical cancer cases and are only transmitted through sexual contact.

"It all comes down to morals," said Mazzotta, who was a poll respondent who agreed to a follow-up interview.

Many know of issue

The poll, which has a 3.5 percentage point margin of error, showed wide recognition of the issue, with 80 percent of residents saying they were aware of the issue or that Kentucky lawmakers were considering a bill. That percentage was higher for women than men -- 87 percent compared with 72 percent.

The bill has undergone changes since the poll questions were written, and the latest version of the legislation, House Bill 345, includes an easier way to opt out than the original version.

Dr. Diane D. Davey, of the Department of Pathology and Laboratory Medicine at the University of Kentucky, said including information about opting out in the survey questions might have brought different poll results. But opponents interviewed said having an opt-out provision doesn't change their view.

Respondents were also asked whether they believe vaccinating middle school girls would make them more likely to have sex earlier or not make much difference. Almost three-quarters -- 73 percent -- said it wouldn't make much difference, although that number was a slightly lower 67 percent for respondents who attend religious services weekly or almost every week.

Still, some opponents raised moral objections, in addition to saying that a mandate would wrongly supersede parents' rights.

"I don't think it should be mandated. I think young girls should be discouraged from having premarital sex," said respondent Julia Walker of Louisville, the 42-year-old mother of two teenage girls. "Young girls should be taught to keep themselves healthy."

Making it mandatory

Davey, co-author of the American Cancer Society's recently published human papillomavirus vaccine guidelines, said she understands why some people may think it's too early to make the vaccine mandatory. But she favors legislation requiring the vaccine as long as there is a way to opt out.

"Requiring the vaccine is the best way to protect the largest number of women from cervical cancer in the long term," she said.

She added that there's no evidence of safety problems, although there isn't enough evidence to evaluate its safety in pregnant women. Officials from the U.S. Centers for Disease Control and Prevention plan to present data today about side effects in people who got the vaccine.

According to the Associated Press, there have been 542 adverse health complaints, including injection site soreness, fainting or dizziness and fever or nausea, but government health officials say no additional warning labels are needed.

Overall, Davey said, the vaccine has been extensively studied, with commercial development beginning in 1993, following a decade of academic research. "There's no evidence, to my knowledge, that this vaccine" was rushed through the federal approval process, she said.

Like Davey, poll respondents favoring mandatory vaccinations stressed the health benefits of Gardasil, which is considered most effective when given before girls become sexually active.

Brown was among the 49 percent of African-American respondents in favor of requiring the vaccine, who outnumbered the 44 percent opposing the idea. The difference was well within the 15 percentage point margin of error for African Americans.

Among Jefferson County residents, 42 percent favor making the vaccine mandatory, compared with 40 percent in opposition. Those figures also fell within the margin of error.

"I've had some of my family that's died with cancer. I think that it's wonderful to have this vaccine," said Shirley Elliott, 71, of Louisville.

And she doesn't believe it would encourage earlier sex among teens. "My God, they're doing it now," she said.

State Rep. Kathy Stein, the Lexington Democrat who sponsored the first version of the vaccine bill, said she believes more people would support the current legislation now before the House if they realized "it is in no way mandatory" because parents can easily opt out. To opt out of other required vaccines, parents must get a written sworn statement.

She said she wished the poll results showed more people in favor of requiring the vaccine, but that vocal opponents such as the Family Foundation of Kentucky may have swayed public opinion.